Question Easy:
A 55-year-old woman presents with gradual hearing loss on the right side. She states she has no pain but has noticed a ringing sensation in her ear. Which of the following is the most likely diagnosis?
A) Otitis media
B) Meniere’s disease
C) Acoustic neuroma
D) Otosclerosis
E) Presbycusis
Explanations & Answers:
Question Easy Answer: C) Acoustic neuroma
Question Easy Explanation: Acoustic neuroma, or vestibular schwannoma, is a benign tumour arising from the Schwann cells lining the vestibulocochlear nerve. Symptoms include unilateral hearing loss and tinnitus without pain. Immediate referral for MRI is indicated for definitive diagnosis. According to NICE guidelines, early detection is crucial to prevent further complications.
Question Medium:
A 24-year-old patient presents with sudden onset of vertigo, decreased hearing, and tinnitus in one ear that developed over the past few hours. There is a history of previous episodes, but this is the most severe. What is the most appropriate initial treatment?
A) Oral steroids
B) Antiviral medications
C) Vestibular rehabilitation
D) Betahistine
E) Surgery
Explanations & Answers:
Question Medium Answer: A) Oral steroids
Question Medium Explanation: Sudden onset of vertigo, decreased hearing, and tinnitus suggests Meniere’s disease. Acute management often includes oral steroids to reduce inflammation and improve symptoms, in line with NICE guidelines. Betahistine may be used for long-term management but is not favored in the acute setting, and antivirals are generally not indicated unless there is suspicion of an infectious cause.
Question Hard:
A 40-year-old man presents with a painless red eye, reduced visual acuity, and photophobia. On examination, there is ciliary injection and a hypopyon. What is the most likely diagnosis?
A) Acute angle-closure glaucoma
B) Anterior uveitis
C) Conjunctivitis
D) Scleritis
E) Corneal ulcer
Explanations & Answers:
Question Hard Answer: B) Anterior uveitis
Question Hard Explanation: Anterior uveitis, or iritis, is characterized by the symptoms described. The presence of ciliary injection, decreased visual acuity, photophobia, and hypopyon are highly suggestive. According to NICE guidelines, prompt referral to ophthalmology is crucial for further evaluation and treatment, which often involves topical corticosteroids and cycloplegics.
Medical fact of the day: The most common cause of inherited hearing loss in the UK is mutations in the GJB2 gene, which encodes the protein connexin 26, essential for cochlear function. Early genetic counseling and testing can help in the management and planning for affected families.
Quote of the day: “Healing is a matter of time, but it is sometimes also a matter of opportunity.” – Hippocrates